NYeC Digital Health Conference 2013: the trends

The third annual New York eHealth Collaborative (NYeC) Digital Health Conference in New York City attracted several hundred people from the worlds of hospitals, public health, academia, policy makers and health insurers–and the myriad related products and services which will enable these entities to improve their health IT, organization and engage patients in their own health. If there were three buzzword phrases setting the tone, they were interoperability, patient portals and technological innovation. All relate to data–data transfer of patient records between providers to be available regionally (RHIOs) and throughout the state via the SHIN-NY health information exchange (HIE); using data to help people visualize and improve their health; putting data into ‘whole person’ context for providers, integrating it into workflows and to save lives; using data to serve process improvement and tougher standards. And finally there is that old devil cost: reducing the cost of care, reducing expensive readmissions plus co-morbidities and making those tools to do this job more affordable for providers and patients.

NYeC has developed considerably since its early days seven years ago as a coordinator of local information exchanges (RHIOs) ex NYC and (paradoxically in the midst of proliferation) proponent of and guide to best EHRs in primary care practices. Now EHRs are consolidating (and over 40 percent of practices are discontented with their present ones), doctors and hospitals must continue on the road and fulfill Stage 2 Meaningful Use for incentives. One key part, patient portals, will be the signature of 2014. On day one of the conference, NYeC announced their large bet on a small company, Mana Health, to create a statewide patient portal. Also announced was that the SHIN-NY (‘shiny’) network is now classed under New York state law as a public utility to advance the goal of interoperability.

The excellent Thursday opening keynote by Kaiser Permanente’s CEO George C. Halvorson mainly focused on how their restructured HIT in their $55 billion ‘total care’ system is being used to improve care delivery, provide decision support to care teams, reduce health disparities within their own patient population and most interestingly, using their ‘big data’ to determine causality in population health studies. Example: confirming the 2-3 times higher risk of autism when a certain antidepressant is used in the 1st and 2nd trimester (but not in the third).

Another ‘pivot’ that NYeC successfully accomplished is to support innovation where it counts in the early stages through its association with the Partnership for New York City Fund. They created the NY Digital Health Accelerator (NYDHA) in October 2012 with a joint investment of $4.2 million and a development base for eight HIT companies [TTA 14 & 23 May] including recently acquired Avado [TTA 8 Nov] and mobile care coordinator Curatr. Thus tech innovations were showcased in large parts of the conference on panels and on the single small exhibit floor. One shift is that all systems have mobile–smartphones and tablets–as a ‘given’ or near-given baked into the design–though the usability on desktops, particularly for hospital systems, has to function just as well. The one session on mobile health per se moderated by David Lee Scher, MD focused on on consumer apps: design simplicity, patient chronic disease management, pulling the data into clinical workflows, and the FBQs’* ‘who pays and how much’. An interesting concept here was to look to the pain point first in setting the pricing. The newer perspective on mHealth is open software architecture and APIs (application programming interface) to break down the barriers on integrating mHealth; this is the focus of Open mHealth co-founded by Cornell NYC Tech Professor Deborah Estrin.

On Friday, there were many opportunities to hear more about emerging and startup companies across two sessions.

Medical Avatar can best be described as a mashup of art, patient engagement,’It’s a Wonderful Life’ and ‘The Portrait of Dorian Grey’. By visualizing the road you shouldn’t travel health-wise, it uses the avatar and an anatomically correct body/parts to project outcomes based on your behavior in order to change it. For smokers, showing osteoporosis, amputations and aging skin can be a convincing revelation. On the positive side, a patient can use it to depict their condition and their symptoms, which are converted into a pictorial representation on the whole body that can aid a doctor in diagnosis. CEO Virgil Wong took us on a short journey through its evolution and also a related study on using visualization in a smoking cessation research study at Columbia University.

The University of Michigan’s otolaryngology department is pioneering the use of 3D printing in their reconstructive surgeries. Using a customized EOS printer and design software, they can construct in bioplastic (resorbable or otherwise) or other materials bespoke surgical models, guides, scaffolds, prosthetics and even organs–within 24 hours. Glenn Green MD, a professor in the department, demonstrated the dramatic life-saving surgery and a tracheal splint used in February 2012 to save the life of an infant in lung/heart failure. (article)

No conference can avoid Google Glass and Heather Evans, MD, a surgical director at Harborview Medical Center in Seattle, Washington gave us a tour of how she and her colleagues are using it. Her live Glass-to-Glass visit to the end of a minimally invasive hernia surgery was a little over the top, but vivid in illustrating its advantages: giving an edge in the ‘critical moment’, the computer in your face is better than the one in the hand, its total integration with the Google World Schema. Dr. Evans’ writeup in the Association for Academic Surgery tells more on her experience.

And in the startup showcase Friday afternoon, this Editor could only stay for the first half of nine presentations representing an impressive cross-section of new (and not so new) companies:

SaferMD: developed by a team at Maimonides Medical Center in Brooklyn, NY, it notifies doctors and patients of test results and provides documentation/analytics that reduce malpractice costs and improve patient safety. They are currently working with payor Blue Cross Blue Shield of South Carolina (BCBSSC)

Aver Informatics: a ‘big data’ analytics company that concentrates on Episodes of Care (e.g. orthopedics) and population health management.

RightCare+ Solutions software performs risk-stratification from admissions through discharge and referral to post-acute care providers. It also enables care transitions and workflows.

Ireland’s GetHealth, a veteran of the GE-StartUpHealth program, provides mobile and desktop behavioral change and support for those in the middle of the population who would like to be healthier, while measuring their ROI using a simple, social and fun approach. They are targeting company HR/Wellness managers who are seeking wellness programs.

CareInSync provides a mobile-only Carebook for care coordination which integrates with hospital EHRs and provides clinician access from admission through stay and discharge/after care. Like RightCare+, it addresses the ‘last mile’ known as home care.

In summary, this was a conference that was well-organized in a strong venue, carried through its focus as stated in depth, and introduced interesting speakers and companies to a hospital, health plan and policy maker audience.

Our definitions

Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:

• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.

• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.

Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.